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Personality disorders

 

A person with an antisocial / dyssocial personality disorder is characterized by a cold indifference to the feelings of others and a lack of empathy. Evidence of behavioral disorder that began before the age of 15 have been demonstrated. The condition manifests itself already in adolescence and continues into adulthood.

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The person with dyssocial personality disorder appears with a lack of responsibility and respect for social norms, rules and / or obligations. He or she often has an inadequate ability to stay in relationships with other people, but has no problems establishing new relationships.

The person has a low frustration tolerance or a low threshold for resorting to aggressive behavior. Often these people may have violent behavior, and they are overrepresented in violent crime. The person has an inability to feel guilt or to learn from experience or punishment. They tend to come up with explanations and to be projecting, i.e. to "project" blame on others for their own negative sides.

 

New treatment line for personality disorders

In a new treatment line for personality disorders made by Oslo University Hospital, it is written: 

- People with antisocial personality disorder show behavior from the age of 15 in the form of a persistent pattern that is characterized by neglect and violation of the rights of others. In addition, there must be a behavioral disorder that started before the age of 15, characterized by a persistent pattern of behavior where the fundamental rights of others or key age-appropriate social norms are violated.

To be diagnosed (according to DSM‐IV), the person must have at least 3 of the following 7 symptoms and signs:

 

  1. Does not follow social norms for law-abiding behavior, shown by repeated acts that provide grounds for arrest
  2. Persistent irresponsibility that manifests itself in repeated failures in stable work-life or in financial obligations
  3. Impulsivity or lack of ability to plan for the future
  4. Fraud, which manifests itself by repeated lies, use of false names, or by deceiving others for their own gain or pleasure
  5. Irresponsible contempt for one's own or others' personal safety
  6. Lack of remorse, manifested by indifference to or explanaing away, that one have hurt, abused or stolen from others
  7. Irritability and aggression manifested by repeated fights or assaults

  

Assessment / screening for antisocial or dyssocial personality disorder

Robert Hare's "Psychopathy Checklist" consists of 20 characteristics with a points system:

If you are unsure whether the person in question has this or that trait: 0 points
Are you almost sure: 1 point
Are you absolutely sure: 2 points

Here are the 20 character traits. Think through each point and set points. Afterwards, add up the points.

 

  1. Smoothness / superficial charm
  2. Egocentricity / ideas of greatness about self-worth
  3. Need for impulses / easy to get bored
  4. Pathological lies / fraud
  5. Bluffing / manipulation
  6. Lack of remorse or guilt
  7. Lack of depth of emotion
  8. Insensitivity / lack of empathy
  9. Parasitic lifestyle
  10. Intrusive / poor control of anger
  11. Active, sexual behavior with multiple partners
  12. Behavioral problems before the age of 12
  13. Lack of realistic long-term planning
  14. Impulsivity
  15. Irresponsible parental behavior
  16. Frequent marriages / cohabitation relationships
  17. Juvenile delinquency before the age of 15
  18. Failure during probation or release
  19. Lack of responsibility for own actions
  20. Several types of offenses including the following 10 types: burglary, robbery, illicit drug use, deprivation of liberty, murder (attempted), illegal possession of a weapon, sexual assault, gross negligence, fraud, escape from prison.

Results:

Under 20 points: The person must be considered a case of doubt
Over 25 points: The person is within the limits of the psychopathic personality disorder

 

Treatment of antisocial personality disorder 

There are major challenges associated with the treatment of antisocial personality disorder, which is about the core issues in this disorder.

The new treatment line for personality disorders created by Oslo University Hospital reads:

- There is a lack of evidence for the treatment of this personality disorder (Cochrane, NICE). Many attempts are made at approaches, including a mentalisation-based treatment, but no studies have been performed that can show an effect.

There is now considerable evidence that there are two main pathways in the development of dyssocial PF. A subgroup of children already at the age of 4 has hard and insensitive emotional traits (callous unemotional traits), and it is believed that this subgroup is a precursor to later development of antisocial personality disorder. These children do not respond to the usual approach and, for example, do not care about punishment or sanctions.

In adults with a high degree of psychopathy and a lot of narcissism, no treatment has been found to work, while in the group without or with limited degree of psychopathy, they are more optimistic.

The degree of psychopathy should therefore always be evaluated at the diagnosis of dyssocial PF. If the patient does not have these traits, and has a sound recognition of his/her vulnerable aspects, one can consider systematic psychotherapy and comorbid emotional instability can be treated as with emotionally unstable PF.

If the patient needs a mastery-oriented course for his aggression, refer to the Anger Mastery Course and / or Alternative to Violence (ATV).

In the following overview article provides an overview of the latest research on the treatment of psychopathy. Part of the conclusion is that there is no agreement in the field on effective methods for treating psychopathy.

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Written by

ove heradstveit

Ove Heradstveit

Psychologist, specialist in clinical community psychology. PhD.
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